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Anemia

Anemia means your blood is short of healthy red blood cells or hemoglobin, so less oxygen reaches your body. It is a sign of something else — the most important step is finding out why.

Call 911 or go to the emergency room now for any of these:

  • Chest pain or discomfort, shortness of breath, or feeling weak, light-headed or faint — these can be signs of a heart attack (CDC). Serious anemia can itself cause chest pain and shortness of breath (NHLBI).
  • Vomiting blood (bright red, or dark like coffee granules) together with feeling faint or dizzy, confusion, fast or shallow breathing, cold, clammy, pale skin, tummy pain or black poo (NHS). Don’t drive yourself.
  • If you have sickle cell disease: severe pain; chest pain with cough, fever and shortness of breath; sudden weakness or numbness on one side, confusion, or trouble speaking, seeing or walking; or an erection lasting 4 hours or more. A fever over 101.3°F (38.5°C) needs medical care and antibiotics right away (NHLBI).

See a doctor soon for:

Don’t wait for a chiropractic, acupuncture or massage appointment for any of these, and don’t start iron pills to “fix” tiredness before you know the cause.

Anemia is a sign, not a diagnosis

Anemia means your blood has fewer healthy red blood cells than normal, or too little hemoglobin (NHS). Hemoglobin is the iron-rich protein that carries oxygen from your lungs to the rest of your body (NHLBI), so with anemia your body doesn’t get enough oxygen-rich blood (NHLBI).

There are three main reasons it happens: blood loss, the body not making enough red blood cells, or red blood cells being destroyed too fast (MedlinePlus). Mild anemia is common and treatable, but anemia can also be a sign of something more serious, such as bleeding in the stomach, inflammation from an infection, kidney disease, cancer or an autoimmune disease (NHLBI). That is why the first step is always to find the cause: treatment depends on the type of anemia and how serious it is (NHLBI).

About 3 million people in the United States have anemia, according to CDC figures quoted by NHLBI (NHLBI).

Common symptoms

Mild anemia may cause no symptoms at all. When symptoms come, they may develop quickly or slowly and often include weakness, tiredness, pale skin, chills, shortness of breath, headache, dizziness or fainting (NHLBI). Iron deficiency can also bring spoon-shaped nails, hair loss, restless legs, or cravings for non-food items such as ice (called pica) (NHS); low B12 or folate can cause a sore red tongue and changes in memory and thinking (NHS). See our Chronic Fatigue, Fainting and Headaches guides; an MBHA Restless Legs guide is planned.

Who is more likely to get anemia?

Risk is higher during menstrual periods and pregnancy, with age, with a family history of inherited anemia, with heavy drinking, and with long-term kidney disease, cancer, autoimmune disease, chronic infection or chemotherapy (NHLBI). Frequent blood donors and infants born early or small are also at risk (MedlinePlus), as are people who absorb iron or B12 poorly because of celiac disease, Crohn’s disease, ulcerative colitis or stomach and weight-loss surgery (NHLBI). See our Kidney, Cancer, Celiac Disease, Crohn’s Disease and Colitis guides.

How doctors find the cause

Your doctor will ask about your health, diet, medicines and family history. The usual first test is a complete blood count (CBC), which measures red blood cells, hemoglobin and the size of your red cells (NHLBI). Further tests follow the clues:

Why it matters

Left untreated, anemia can raise the risk of heart problems — an irregular heartbeat, an enlarged heart and heart failure — as well as infections and pregnancy complications, and in children it can cause developmental delays (NHLBI). See our Heart guide.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Find and treat the cause: iron, vitamin B12 or folic acid; stopping hidden bleeding; treating the underlying disease; transfusion; and for some types, immune-calming medicines or a stem cell transplant. Cost estimate being researched. Medicare Parts A and B cover blood services. Iron stores often take 3–6 months to rebuild; some people need B12 for life. Nerve damage from low B12 may be permanent, so early treatment matters.
Chiropractic No role in treating anemia, though a chiropractor may spot warning signs and refer you. About $55–$100 for a follow-up visit and $90–$200 for a first visit without insurance. Medicare Part B covers only spinal adjustment for subluxation (20% coinsurance). No studies of chiropractic as an anemia treatment. Tell your chiropractor if you bruise or bleed easily.
Acupuncture Studied in small trials for iron deficiency and for sickle cell pain. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Two small trials reported better blood counts; neither replaces finding the cause. Ask your hematologist first if your blood counts are low.
Herbal medicine Foods rich in iron, B12 and folate first; East Asian herbal formulas studied in children; homeopathic remedies such as Ferrum phosphoricum (see Homeopathy). Cost estimate being researched. Limited evidence for herbs; no good-quality evidence that homeopathy treats anemia. Some imported remedies contain lead, which can itself cause anemia.
Massage therapy Gentle massage for comfort, stress and pain, not to treat the anemia itself. One national chain’s memberships run about $70–$90 a month. Medicare doesn’t cover massage ordered by a chiropractor. May ease pain, stress and anxiety for a while. Low risk; use gentle pressure if you bruise or bleed easily.
MBHA Wellness Coach Meals rich in iron, B12 and folate; vitamin C with iron-rich foods; sticking with treatment and follow-up blood tests; iron stored away from children. Cost estimate being researched. Supports — never replaces — the medical workup. Diet can’t fix bleeding or absorption problems.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the type of anemia and how serious it is. Mild anemia may not need treatment, and if a medicine or another health condition is causing it, your doctor may change that treatment (NHLBI). We don’t list doses; follow your own doctor’s directions.

Iron-deficiency anemia

  • Find the reason first — for example an ulcer or heavy periods — then treat it (NHS). Heavy periods can be treated with medicine (NHS) — see our Female Problems guide — and surgery may be needed to stop internal bleeding (NHLBI).
  • Iron pills are the most common treatment and often take three to six months to restore iron levels (NHLBI). Side effects can include constipation or diarrhea, stomach pain, nausea and darker stools; taking them with or soon after food may help, and repeat blood tests check that levels are recovering (NHS).
  • IV iron, given through a vein, often restores iron in one or a few sessions and is more likely for serious iron deficiency or long-term conditions (NHLBI).
  • Iron is not for everyone. Iron supplements are generally not given to people who don’t have iron-deficiency anemia, because too much iron can damage organs (NHLBI).

Keep iron tablets out of children’s reach. An overdose of iron in a young child can be fatal (NHS). Extremely high iron levels can lead to organ damage, coma and death (MedlinePlus). If a child swallows iron pills, call 911 or Poison Control right away.

Vitamin B12 and folate deficiency

  • Vitamin B12 can be prescribed by mouth, as a nasal spray or as shots (NHLBI). When the cause is not diet — for example pernicious anemia — injections are usually needed for life (NHS).
  • Folate deficiency is treated with folic acid tablets, usually for about 4 months. Your doctor will check B12 first, because folic acid can hide a B12 deficiency that would keep harming the nerves (NHS) — one more reason not to self-treat.
  • Nerve symptoms such as numbness and tingling may not go away even with treatment (NHLBI).

Anemia of chronic disease (inflammation)

The main treatment is treating the underlying condition. Doctors may also prescribe medicines called ESAs that help the bone marrow make red blood cells, often with iron (NIDDK).

Aplastic and hemolytic anemia, and sickle cell disease

Aplastic anemia may be treated with transfusions, medicines that stop the immune system attacking the bone marrow, and blood or bone marrow transplants, which may cure it in some people (NHLBI). Hemolytic anemia may need transfusions, medicines, removal of the spleen or a transplant (NHLBI). Sickle cell disease is lifelong and managed with screening and treatment; in December 2023 the FDA approved two gene therapies for it (NHLBI).

Transfusion and transplant

A blood transfusion through an IV line usually takes 1 to 4 hours and quickly raises red blood cells in serious anemia. Donated blood is carefully tested, the chance of getting HIV is less than one in a million, and frequent transfusions can cause iron overload. A bone marrow (stem cell) transplant replaces faulty blood-forming cells; it is effective for some conditions but can cause serious complications, such as infection and graft-versus-host disease (NHLBI).

What it costs

Medicare Part A covers blood you get as a hospital inpatient and Part B as an outpatient. If the provider has to buy the blood, you pay for the first 3 units in a calendar year unless you or someone else donates to replace it; outpatients pay a copayment for processing and handling (Medicare.gov). Doctor visits, blood tests, iron, B12 and other treatments: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating anemia. We searched PubMed and found no studies testing chiropractic care or spinal manipulation as a treatment for anemia — only case reports.

One case report shows how a chiropractor can still help: a 67-year-old woman with neck and back pain, deep tiredness and pale skin had blood tests showing severe anemia, and quick referral led to a diagnosis of leukemia (case report, 2023). See our Leukemia guide.

Safety

Chiropractic may not be safe for people at increased risk of bleeding or with very weak bones (NHS). Some anemias, such as aplastic anemia, cause easy bruising or bleeding (NHLBI), so tell your chiropractor about your diagnosis and blood counts.

Coverage and cost

Medicare Part B covers only spinal adjustments to correct a subluxation; you pay 20% after the deductible, and it doesn’t cover tests or other services a chiropractor orders (Medicare.gov). Without insurance a follow-up visit costs about $55–$100 and a first visit about $90–$200 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

What the research says

  • In a 2023 trial in India, 100 women with iron-deficiency anemia had needling at three acupuncture points or at non-acupuncture points every day for 2 weeks. Hemoglobin rose in the acupuncture group and not in the comparison group (Devi et al., 2023). The trial was short and did not compare acupuncture with iron treatment.
  • In a 2017 trial in China, 60 people with obesity and low iron all took iron pills; those who also had acupuncture for weight loss improved their iron and hemoglobin more than those given sham acupuncture (Xie et al., 2017).
  • Sickle cell pain: in a pilot study of six adults with chronic sickle cell pain, all reported less pain and no side effects (Li et al., 2021). A 2023 review of 24 studies in children found that acupuncture, yoga and virtual reality lowered pain scores in hospital, but effects on emergency visits and hospital stays were unclear (Alsabri et al., 2023). A sickle cell pain crisis still needs medical care right away (NHLBI).

Safety

Relatively few complications have been reported; the FDA requires sterile, single-use needles and most states license acupuncturists (NCCIH). Acupuncture may not be safe if you are at increased risk of bleeding (NHS). In one case report, a woman with aplastic anemia and a very low white blood cell count developed a life-threatening tissue infection after acupuncture; the authors urge extreme caution in high-risk patients (Hsieh et al., 2011). If your blood counts are low, ask your hematologist before any needling.

Cost

Medicare covers acupuncture only for chronic low back pain (Medicare.gov). Cash prices run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics charge about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb can replace iron, vitamin B12 or folic acid when your body is short of them, or stop hidden bleeding. Food comes first — see “Eating for healthy blood” below.

East Asian herbal formulas

A 2024 review pooled 28 trials of East Asian herbal medicine for iron-deficiency anemia in children, most of them using herbs together with iron. Blood counts improved more than with iron alone, with fewer stomach side effects, but the authors say larger, well-designed trials are still needed. The herbs used most often were astragalus, atractylodes and angelica (dong quai) (Jeong et al., 2024).

  • Astragalus: there isn’t enough reliable evidence to know whether it helps any health condition. It might worsen autoimmune diseases and may interact with medicines that suppress the immune system, and its safety in pregnancy is unknown (NCCIH). This matters for anemia: pernicious anemia is autoimmune (NHS), and aplastic anemia is most often caused by the immune system attacking the bone marrow (NHLBI).

A hidden danger: lead in some remedies

Some Ayurvedic preparations contain lead, mercury or arsenic in toxic amounts (NCCIH). A 2025 review of 210 published cases of metal poisoning from traditional and alternative medicines, mostly from Asia and mostly lead or arsenic, found that anemia was common and that the true cause often went unrecognized for a long time (Gerke and Seifert, 2025). If you have anemia and take any imported remedy, tell your doctor.

Check with your doctor or pharmacist before any herb or supplement. Herbal medicines are not recommended for children, or in pregnancy, breastfeeding, or kidney or liver disease, and some interact with prescription medicines (NHS). “Natural” doesn’t always mean safe (NCCIH). We don’t list doses.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage doesn’t treat anemia, but it may help with comfort, pain and stress, especially for people living with a long-term blood condition.

What the research says

  • A children’s hospital reviewed 3,015 massage sessions given to 243 young patients with blood disorders or cancer, 72 of them with sickle cell disease. On average, patients reported less pain, stress and anxiety after their sessions (Rodgers-Melnick et al., 2023). There was no comparison group.
  • A 2023 review of drug-free pain treatments for children with sickle cell disease found only one massage study; cognitive behavioral therapy and biofeedback had the most support (van Veelen et al., 2023).

Safety and cost

The risk of harm from massage appears low, but rare serious problems such as a blood clot, nerve injury or broken bone have been reported, some after vigorous deep-tissue massage (NCCIH). If you bruise or bleed easily, tell your therapist and ask for gentle pressure. Never use massage in place of urgent care for a sickle cell pain crisis (NHLBI). Memberships at one national chain run about $70–$90 a month (The Pricer). Medicare doesn’t cover massage therapy ordered by a chiropractor (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your doctor’s plan into daily habits — alongside, never instead of, the medical workup.

  • Meal planning around the iron, B12 and folate foods listed under “Eating for healthy blood” below. Large amounts of tea, coffee and dairy make iron harder to absorb (NHS), so MBHA suggests having them between meals.
  • B12 if you eat little or no animal food: vegans need B12 supplements or fortified foods (NHS). If you are a strict vegetarian or vegan, talk to your doctor about getting all the nutrients you need (NHLBI).
  • Alcohol: drinking too much raises the risk of anemia and makes B12 harder to absorb (NHLBI, NHLBI).
  • Sticking with treatment: keep taking iron tablets even if they cause side effects, unless your doctor says otherwise, and go to your follow-up blood tests (NHS).
  • Pacing your energy while your blood counts recover, and noting symptoms to share with your doctor.
  • Safety at home: store iron tablets where children can’t reach them (NHS).

If your diet is part of the cause, your doctor may refer you to a dietitian (NHS).

Another approach

Types of anemia at a glance

Iron-deficiency anemia

The most common type. It usually comes from blood loss — heavy periods, bleeding in the stomach or bowel, injury, surgery or childbirth — or from not absorbing iron well (NHLBI). In pregnancy it is most often caused by too little iron in the diet (NHS). See our Hemorrhoids guide; an MBHA Ulcers guide is planned.

Vitamin B12 deficiency and pernicious anemia

B12 is needed to make healthy red blood cells and to keep the brain and nerves working (NHLBI). In pernicious anemia the immune system attacks the stomach cells that make intrinsic factor, a protein needed to absorb B12; it is more common in women around 60 and in people with another autoimmune condition. Low B12 can also come from a vegan diet without supplements, stomach surgery, Crohn’s disease, or some medicines (NHS). About 1 in 10 people aged 75 or over has a B12 or folate deficiency (NHS).

Folate deficiency

The body stores only about 4 months’ worth of folate. Low folate can come from a poor diet, heavy drinking, celiac disease, some medicines, or extra needs in pregnancy, cancer or sickle cell disease (NHS).

Anemia of chronic disease (inflammation)

The second most common type, usually mild or moderate. It affects people with long-term inflammation — for example rheumatoid arthritis, lupus, cancer, HIV, chronic kidney disease, inflammatory bowel disease, diabetes or heart failure (NIDDK). See our Lupus, Arthritis and Diabetes guides.

Aplastic anemia

A rare but serious condition in which the bone marrow can’t make enough new blood cells of any kind. It is most often caused by the immune system attacking the bone marrow; some medicines, such as chemotherapy, and toxins can also cause it (NHLBI).

Hemolytic anemia

Red blood cells are destroyed faster than they can be replaced, because of autoimmune conditions, infections, some medicines, or inherited conditions such as sickle cell disease and thalassemia (NHLBI) or G6PD deficiency (MedlinePlus).

Sickle cell disease

A group of inherited disorders in which red blood cells become stiff and crescent-shaped and can block blood flow, causing pain crises, stroke and organ damage. It affects more than 100,000 people in the United States (NHLBI).

Anemia caused by medicines

Chemotherapy raises the risk of anemia (NHLBI); regular aspirin or anti-inflammatory painkillers can cause stomach bleeding (NHLBI); and heartburn medicines called proton pump inhibitors, metformin, some epilepsy medicines and methotrexate can lower B12 or folate (NHS). Never stop a prescribed medicine on your own — ask your doctor whether it could play a part. See our Medication Concerns guide.

Another approach

Eating for healthy blood

A good diet helps prevent some kinds of anemia and supports treatment, but it can’t fix bleeding, an absorption problem or a bone marrow disease — so use it alongside, never instead of, the medical workup.

  • Iron: lean meat, seafood and poultry; fortified breakfast cereals and breads; white beans, lentils, kidney beans, spinach and peas; nuts; and dried fruit such as raisins (MedlinePlus), apricots and prunes, and leafy greens such as kale and watercress (NHS).
  • Help iron absorb: eat vitamin C foods such as oranges, strawberries and tomatoes with iron-rich meals (NHLBI). Large amounts of tea, coffee, milk and dairy, and high-phytate foods such as wholegrain cereals, can block iron absorption (NHS).
  • Vitamin B12: lean red meat and chicken; fish such as salmon and catfish; clams and oysters; milk, yogurt and cheese; eggs; and fortified cereals and plant milks (NHLBI). Body stores of B12 last about 2 to 5 years, so a deficiency after a diet change can take a long time to appear (NHS).
  • Folate: leafy greens, fruit, dried beans, peas and nuts, and enriched breads and cereals (MedlinePlus); broccoli, Brussels sprouts, asparagus, chickpeas and brown rice (NHS).

We don’t list daily amounts; ask your doctor or a registered dietitian what is right for you.

Another approach

Anemia in pregnancy and childhood

Anemia, especially iron deficiency, is common in pregnancy because the body makes more blood for the baby. Doctors check for it at different stages and may recommend a supplement besides prenatal vitamins. Serious or untreated anemia can lead to preterm labor, more blood loss during delivery, low birthweight and anemia in the baby (NHLBI). The CDC advises anyone who could become pregnant to get folic acid, because birth defects of the brain and spine can form in the first weeks, often before you know you are pregnant (CDC). An MBHA Pregnancy guide is planned.

Young children can become iron deficient if their diet lacks iron, usually between 9 months and 1 year as they move to solid foods, so make sure toddlers eat iron-rich solids (NHLBI). And keep adult iron tablets locked away: an iron overdose can kill a young child (NHS).

Another approach

Homeopathy

About the evidence. Homeopathic remedies are chosen to match a person’s individual symptoms. There is no scientific evidence that homeopathy treats this condition, and it must never replace prescribed medical treatment.

What homeopaths may suggest

Homeopaths choose a remedy to match a person’s overall pattern of symptoms rather than the diagnosis. For anemia, homeopathic texts describe:

These descriptions come from homeopathic tradition, not from clinical trials. We don’t list potencies or schedules.

What the evidence shows

There is no good-quality evidence that homeopathy treats anemia. NCCIH says there is little evidence that homeopathy works for any specific health condition, and a 2015 Australian government review found no reliable evidence that it does (NCCIH). Homeopathic mixtures are very watered down (NHS), so a homeopathic “iron” remedy cannot replace the iron your body is missing.

Safety

Some products sold as homeopathic contain real amounts of active ingredients, and replacing effective treatment with homeopathy can cause serious harm. Never use it in place of finding and treating the cause of anemia, and check with your provider before using it in pregnancy or for a child (NCCIH).

What it costs

Cost estimate being researched. Ask for a written plan with costs and check the practitioner’s training before starting.

In their own words

Wellness and lifestyle testimonials

Please read first. These are personal experiences, not medical advice. MBHA makes no medical claims: these products do not treat anemia. Anemia always needs its cause found by a doctor. Never stop or change prescribed treatment — iron, B12 shots, transfusions or other medicines — on your own, and talk with your (or your child’s) doctor before trying any product or supplement.

My son had never slept well. He was waking up four to six times a night when, at 18 months, I put him on a magnetic sleep system. Over the past six months he has slept better and better, and now he sleeps through the night a few times a week. He has anemia, and sleep had been a real struggle, so this has meant a lot to our family.

— Name withheld

Shared with first names only. Lightly edited for length and spelling.

Member stories

Living with Anemia? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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